The Senate has adjourned until April 13, 2015 without taking action on the House-approved Medicare Access and CHIP Reauthorization Act, which would repeal the Sustainable Growth Rate (SGR) formula, reform Medicare physician...more

Congressional Hearing on 340B Program Rescheduled for March 24, 2015 – The U.S. House of Representatives Committee on Energy and Commerce, Subcommittee on Health has rescheduled the hearing on the 340B program for Tuesday,...more

Today CMS published a notice updating the Healthcare Common Procedure Coding System (HCPCS) codes on the Durable Medical Equipment (DME) List of “Specified Covered Items” that require a face-to-face encounter and a written...more

In a historic bipartisan moment, the U.S. House of Representatives passed a nearly 300-page bill that is intended to “repeal the Medicare sustainable growth rate [“SGR”] and strengthen Medicare access by improving physician...more

Today the House of Representatives passed H.R. 2, legislation to create a permanent fix to the Sustained Growth Rate (SGR) formula and includes a number of other important health-related policies, including funding for the...more

On March 25, 2015, the U.S. Department of Health and Human Services Office of Inspector General (“OIG”) posted Advisory Opinion No. 15-04. In the opinion, the OIG addresses a laboratory’s proposal to enter into agreements...more

Historic SGR repeal passes in House -
Today, the House of Representatives passed the Medicare Access and CHIP Reauthorization Act, H.R. 2, by a vote of 392–37. This legislation permanently repeals the SGR and returns...more

Yesterday the Office of Inspector General for the Department of Health and Human Services (the “OIG”) issued Advisory Opinion 15-04 (“Advisory Opinion”) in which it found that an exclusive arrangement between a laboratory...more

Repeals SGR Formula, Adopts Medicare and Other Policy Changes -
Today the U.S. House of Representatives approved a major Medicare package, the Medicare Access and CHIP Reauthorization Act (MACRA), which would reform...more

Senate leaves for recess with no action on SGR repeal -
Despite a successful vote in the House yesterday, the Senate failed to bring to a vote legislation to repeal the flawed Medicare Sustainable Growth Rate (SGR)...more

After a decade of short-term actions, congressional leaders are pushing this week to permanently repeal the Sustainable Growth Rate (SGR) formula that governs Medicare physician payment rates, and replace the system with one...more

Tuesday’s post discussed the Seventh Circuit’s holding in United States v. Patel, broadly expanding the definition of “referring” under the Anti-Kickback Statute. Today’s post turns to the question of how other circuits have...more

The Department of Health and Human Services Office of Inspector General (OIG) released an advisory opinion (No. 15-04) today that states a proposed arrangement to provide free laboratory tests for certain patients of...more

A group of bipartisan, bicameral congressional leaders introduced a bill, on March 19, to repeal the Sustainable Growth Rate (SGR) formula that governs Medicare physician payment rates. The formula has called for dramatic...more

When Illinois residents seek surgical treatment they often trust that their physicians will do their best to ensure that they come out of surgery in better condition than they when they arrived. Unfortunately, a Chicago...more

Under the ACA, the Physician Value-Based Modifier (Value Modifier) policy rewards physicians and groups of physicians who provide high quality and cost effective care, while penalizing those who did not meet objectives. ...more

A tip of the hat to our friend and former colleague Ken Zucker from Pepper Hamilton, who achieved this victory and sent us the decision. In the consolidated California Byetta litigation, 2015 WL 663211 (Cal. Super. Feb. 26,...more

New care delivery models and healthcare reimbursement trends are heating up the market for hospital employment of physicians yet again, but does a productivity-based compensation model still work in this environment?...more

Overview -
The term economic credentialing is an old phrase that carries different meanings for different people, especially physicians. Simply stated, it is typically defined as any medical staff credentialing...more

New York State Governor Andrew Cuomo signed an extender for the electronic prescription mandate late last week, pushing the compliance date to March 27, 2016. The law generally provides that “no person shall issue any...more

In reviewing mergers of healthcare providers, government antitrust enforcers have historically focused on horizontal mergers between competing providers—in particular, those that result in high market shares in a specific...more